Ideal Buttock Shape

The ideal buttock shape has been defined by many painters, sculptors, and physicians in human history. Although we see a large cultural variation in what people find as beautiful butts, certain features of the back are universally agreed as aesthetically beautiful. These include:
1) A round or A-shaped buttocks
2) A pleasing V-shaped demarcation between the lower back and upper buttocks with minimal fat
3) No fat above the butt crack (a region normally known as sacrum which can accumulate fat)
4) Minimal fat of the lower back above the upper buttocks. This creates a beautiful curvature of the lower back known as lordosis
5) Tight perky buttocks with no sagging
6) Symmetry
7) Defined lower buttock crease (infragluteal crease) that separate the buttocks from the upper thighs on the back
8) Buttock cheeks that are equal in height and width Buttock shapes have been classified as round, A-shaped, boxy, or V-shaped.

Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift
Buttock Augmentation, Reshaping, Lift

Buttocks After Massive Weight Loss

Most individuals, whether men or women, develop buttock sagging and deflation with significant weight loss. In these patients, the buttocks lose volume, fullness, and shape and often sag as a unit. This means that not only the buttock skin droops but also the buttock crack moves lower. Often there is a roll of lower back tissue (known as the hip roll) that merges with the upper buttocks. Most weight loss patient still feel that they have a large buttocks, but in reality, this is due to the hip roll that makes the buttock area look longer and wider than it truly is. The hip roll is the excess, stubborn fat of the lower back and the love-handles that sweeps forward over the hips and merges with the lower abdominal pannus. It represents lower back excess skin and fat and deforms the buttocks shape. With deflation and sagging, the buttocks’ skin also often forms many dimples and cellulite.

Buttocks lift procedures are performed for those patients who have buttocks sagging, excess buttocks skin, or buttocks dimples and cellulites. A buttocks lift surgery removes saggy skin of the upper buttocks together with that of the lower back hip roll. A buttocks lift always reduces the buttocks size and projection since part of the upper buttocks is excised to lift the buttocks to a higher position. So in essence, every buttocks lift surgery is buttocks elevation and reduction. The lift also flattens the buttocks shape and reduces buttocks projection. To prevent this, buttocks augmentation and reshaping is necessary in order to maintain the buttocks roundness or to even enhance the buttocks size. Hence, Dr. Agha performs a much more comprehensive buttocks lift procedure that the average butt lift.

Buttock Augmentation and Lift

For the majority of weight loss patients who present to us, the buttocks are loose and deflated. These patients will best benefit from a combination of buttocks lift, buttocks augmentation, and buttocks reshaping. Dr. Agha performs his own signature buttocks enhancement procedure that he has termed the high-definition buttocks lift. This procedure combines buttocks lift which reduces buttocks projection, with buttock augmentation to restore or even enhance buttocks projection, and change of the buttocks shape into a round buttocks. During the high-definition buttocks lift, Dr. Agha not only controls the buttocks height, the buttocks projection, but also the buttocks width. For those with wide buttocks and hips, Dr. Agha will narrow the buttocks width and hip circumference. Conversely for those with V-shaped buttocks, Dr. Agha again creates buttocks width at the time of the lift. The high-definition buttocks lift starts with a seagull incision at the demarcation between the future upper buttocks and lower back. The skin of the lower back and upper buttocks in between the 2 incisions of the buttock lift is then removed. The underlying fat is then developed as a fat pad (known as a flap in plastic surgery since its blood supply is preserved and thus all of the fat cells will continue to stay alive). Dr. Agha’ then creates appropriately sized pockets over the buttocks muscles and the fat pads are then rotated into these pockets and secured in position using dissolvable sutures. In this manner the lower back and upper buttocks fat (this is from the hip roll) is used to augment buttocks projection or perkiness. With this approach, Dr. Agha can add moderate or even significant amount of volume back to the buttocks to prevent buttock flattening and increase buttocks size. To reduce buttocks width, Dr. Agha places the fat pads centrally. To create lower and outer buttock fullness, Dr. Agha uses wider fat pads. Finally, the buttocks are lifted to their predetermined position on the lower back to close the seagull-shaped incision.

Dr. Agha’s high-definition buttocks augmentation and lift is designed following the aesthetic principles of buttocks beauty. The procedure is planned with the intention of restoring fullness to the buttocks while creating an hour-glass figure for the female patient. Dr. Agha’s signature buttock reshaping procedure has several components:

Dr. Agha accomplishes buttocks augmentation in 2 ways.
1) Upper buttocks fullness is achieved with the use of lower back fat that is prepared as fat pads and mobilized into pockets that are created over the buttocks muscles on each side.
2) Lower buttocks fullness is created by using liposuctioned fat. This fat can be harvested from many areas such as the waist, love-handles, back, thighs, lower abdominal pannus, etc.

Buttock lift, augmentation, and reshaping typically takes about three hours of the lower body lift procedure.

The high-definition buttocks lift and buttock reshaping is a rather complex surgery that truly requires enhanced training in Plastic Surgery. This procedure is most often done in conjunction with a lower body lift.

Buttock Fat Transfer (Buttock Lipoaugmentation)

In most of the weight loss patients that we see, patients still have a good amount of fat that can be liposuctioned and used for buttocks or breast fat transfer. This is because we specifically tell our patients to plan their surgery when they are 25 pounds above their desired final weight. Dr. Agha believes that a body lift is not just about lifting tissues but sculpting the body as well. Thus he prefers to start surgery when he can sculpt curves into the patient by liposuction, removing fat that can in turn be used for creating projection in the breasts or the butts. For virtually all of his patients, Dr. Agha augments the buttocks with lower back fat pads and then transfers additional fat into the buttocks to enhance shape and size.

Buttock fat transfer, commonly known as a Brazilian butt lift, is not a true buttock lift procedure. It is a buttocks augmentation procedure that results in filling deflated or smaller buttocks with your own liposuctioned fat. The process lifts the buttocks by filling out the loose buttock tissue. A Brazilian butt lift is designed to fill the buttocks so that the final overall shape is a lifted and perkier contour. It involves harvesting your own body’s fat from the flanks, hips, back, thighs, or lower abdomen. Dr. Agha removes fat from selected areas of your body with very gentle liposuction to protect the living fat cells. The liposuctioned fat is then washed with antibiotic solution, processed, and carefully injected into the buttocks as small droplets or a micrograft. During this fat micrografting process, the buttocks can be contoured to the desired shape and size. The fullness and projection of the buttocks can be greatly increased by layering many fine layers of fat micrografts throughout the buttock fatty region.

A Brazilian butt lift on its own is not an ideal buttock enhancement procedure in weight loss patients. This is because:

  1. Success of the Brazilian butt lift is dependent on the amount of fat that can be liposuctioned. In weight loss patients, although there is usually lower back hip roll, upper back rolls, lower abdominal pannus, fuller flanks and thigh fat, not all the hanging tissue represent abundance of fat underneath. The hanging rolls and tissues are made up of fat and connective tissue matrix. In weight loss patients, the majority of the fat is gone, leaving behind a heavy background of mainly connective tissue matrix. Thus liposuction is more difficult and less fruitful in the weight loss patient.
  2. Weight loss patients have lost a great amount of fat from their buttocks. Transferred fat cells require a rich environment of fat to survive in while the transferred cells develop their own blood supply.
  3. Weight loss patients often lose additional weight with each surgery. Thus more of the transferred fat cells are lost in the post-operative period than the average non-weight loss patient.
  4. Most weight loss patients should not have liposuction on its own. Liposuction removes fat from hanging tissues and stubborn areas and results in additional skin looseness and laxity. This is because the weight loss skin does not have the necessary elasticity to contract and shrink after liposuction.

In our practice, Dr. Agha uses liposuction with all of his body contouring procedures. However liposuction and skin excision are performed hand in hand during the same surgery. Often, Dr. Agha liposuctions the patient to harvest fat and to sculpt curves, uses the fat for buttock enhancement and reshaping, and immediately removes the loose and excess skin. Thus body sculpting and body contouring are performed simultaneously. It is important to appreciate that the liposuctioned fat is used in conjunction with lower back fat pads in Dr. Agha’s practice. Because the areas receiving liposuction are now leaner, sculpted, and tighter, the rounder, fuller buttocks will become the beautiful highlight of your sensuous new shape.

Buttocks Reduction/Lift with Reshaping

Most weight loss patients will have significant deflation and sagging of their buttocks. But occasionally the buttocks still have a descent amount of buttocks volume despite sagging. In these cases, the patient may not need additional augmentation and may only desire tightening of the buttocks’ skin through a buttocks lift surgery. A buttocks lift will always:

  1. Reduce the buttocks volume by removing upper buttocks tissue
  2. Reduce the buttocks projection by moving the buttocks tissue higher. This flattens the buttocks.

Like all buttocks surgeries, a buttocks reduction and lift truly requires a very customized strategy. During this procedure, Dr. Agha removes the excess skin and tissue of the upper buttock region and lower back. He will then lift the buttock tissue to a predetermined position on your lower back and will reconstruct the V-shaped depression between the buttocks and the back that is a recognized aesthetic feature. Although, some patients wish to have smaller buttocks, neither male or female patients wish to have flat buttocks. In these patients who want smaller buttocks, Dr. Agha often performs buttock fat transfer (Brazilian buttock lift) to the center of the buttock cheeks to restore roundness and shape to the flattened buttocks. This requires a surgeon who has an excellent knowledge of body proportions, an artistic eye, and a keen three-dimensional sense.

Buttock Implants in Massive Weight Loss Patients

In our practice, most of the post-bariatric patients do not want to have buttock implants. Furthermore with all the available techniques and possibilities, we have never had to use buttock implants in conjunction with a primary lower body lift. However, if a patient has no fat and implants are needed, Dr. Agha will be more than happy to use buttock implants for buttocks enhancement. To learn more, visit our buttocks implant page.

Dr. Agha’s Experience Matters

Buttock enhancement is often the most challenging part of a total body transformation. Most patients have significant deflation, distortion, and asymmetry of this region. Furthermore, no two patients have the same butt. Thus, for every patient, a customized plan has to be established during the consultation procedure. Rest assured Dr. Agha is an expert at this. Over the course of hundreds of buttock lifts, Dr. Agha has established the following priorities:

  1. A beautiful butt may need more than one surgical approach. Hence, Dr. Agha often performs buttocks enhancement with lower back fat pads as well as Brazilian butt lift in every patient
  2. Rome was not built overnight and neither your butts will be. Dr. Agha usually start a full body transformation with a lower body lift and buttocks enhancement. During this first stage, he will do buttocks lift and enhancement. However, he is always planning to revisit this area if more shaping and enhancement is needed. This can often be done easily during future surgeries when liposuctioned fat from the upper body or thighs can be transferred to make the buttocks perkier or more even.
  3. Dr. Agha prefers to start a total body transformation when the patient is about 25 pounds above the weight that they wish to end up at. This is because a total body lift will in most cases result in 20 pounds of weight removal. Furthermore, excess weight is needed so that the patient can be sculpted with liposuction and the fat can be used for buttocks enhancement.
  1. Knowing where to place the butt scar requires planning and experience. The butt scar should end up as a nice v-shaped curve, demarcating the lower back and the upper buttocks. If the scar is placed higher on the back, the buttocks will be elongated rather then round. If the scar is too low on the buttocks, the butt will appear too short. Thus precise positioning of the scar is paramount to a great result. Also, many surgeons make their butt scars straight along the back. This invalidates buttocks beauty by making butts square and unnatural. Look at our gallery to see how perfectly each buttock scar is placed correctly to achieve round and natural looking buttocks.
  2. Sometimes buttocks are V-shaped and require reshaping to become rounder or A-shaped. Here Dr. Agha rotates the buttock tissue out to create width while he enhances projection of the central and lower buttock cheeks.
  3. Sometimes buttocks are too wide and need to be narrowed. In these case, Dr. Agha rotates buttock cheeks inwards to reduce the buttocks and hip width.

Buttock Lift Redo

Every year, Dr. Agha performs about 5 or more body lift redos. These are surgeries that have been done by other plastic surgeons. Often the buttocks were not enhanced or reshaped. Patients also always want a revision of the butt scar which may be too low on their butt, or too high on their back, or uneven or straight. Although buttock reshaping and enhancement can be easily done with buttocks fat transfer (as long as there is fat), buttock scar revision is not always so easy. If the buttock scar is low, correction of scar position will result in further flattening of the buttocks. If the buttock scar is too high on the lower back, then it can not be lowered for more than an inch since the lower back skin is very adherent and does not move easily.